Provider Demographics
NPI:1164944641
Name:MILLBOURNE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MILLBOURNE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIAOBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-813-9430
Mailing Address - Street 1:6786 MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2431
Mailing Address - Country:US
Mailing Address - Phone:610-553-7368
Mailing Address - Fax:610-553-7414
Practice Address - Street 1:6786 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2431
Practice Address - Country:US
Practice Address - Phone:610-553-7368
Practice Address - Fax:610-553-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies